Begin the Dialogue

The next step for the clinician is to identify the Stage of Change. This allows you to negotiate possible change and advise the client/patient accordingly.

What does your patient sound like right now? The following flip cards show what a patient/client might say in each stage. TAP to see what you could say in response.


The patient is not yet recognizing the problem or considering change. The clinician's goal is to build rapport and raise awareness.

I don't have a problem with anything. I share a few beers with my buddies on the weekend that's all.
If you would ever like to talk about available options, I would be happy to meet with you.

The patient/client is evaluating reasons for and against change. Clinician's task is to explore and resolve ambivalence - a good time to address pros/cons

I've been thinking I might try to stop drinking so much when I go out with my friends.
It sounds like you enjoy being with your friends, but you've had a number hangovers that have gotten in the way of completing your work or even getting to work.

The patient/client is planning for change. Express empathy, negotiate a plan, and facilitate decision-making.

I don't want my kids to think I'm a drunk. Can you tell me where I can go to get help?
It's clear that you are trying to change. I would be happy to work on a plan with you.

The patient/client is making the identified change(s). Clinician's task is to support self-efficacy and the implementation of the plan.

My family is very important to me so I attend group at XYZ on Tuesday and Thursday nights.
I can see that you have been working on your goal. You have stopped drinking in the last month and are attending meetings. With your dedication I'm sure you will be successful.

The patient/client is working to sustain change(s). Clinician's goal is to help maintain change and prevent relapse.

I have recently become a sponsor in AA. It has helped me to stay sober. I haven't drank in over 18 months.
It's good to see you. You have maintained your commitment not to drink for over a year. I can see that you have been working very hard.

Event(s) trigger the individual to return to previous behaviors. Clinician's goal is to re-engage and review goals. Recurrence does not equal failure.

I slipped up last weekend and went to the bar with a couple of my former drinking buddies.
A number of things can trigger someone to drink. You developed a plan that worked for you before. What are your thoughts on that?

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